Hazard Report Form - Section Two

Please complete Section Two of the Hazard Reporting Form. A copy of this report will also be emailed to safety@swek.wa.gov.au immediately after completion. If you have any questions, please contact Safety & Wellbeing Officer Stephen Lockie on 08 9168 4100 or stephen.lockie@swek.wa.gov.au

Supervisors, please complete the following Section

Supervisor Name*

Supervisor Email*

I have investigated the above hazard and make the following observations*

Please type in your full name. By typing in your name, you are agreeing that the above information is correct.*

Date*

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